Myocardial viability assessment in ischemic cardiomyopathy: benefits of coronary revascularization.

Patients with ischemic heart disease, congestive heart failure, and low ejection fraction are usually referred for orthotopic heart transplantation. Based on results of myocardial viability assessment, we have prospectively used either coronary artery bypass grafting or orthotopic heart transplantation. From January 1990 to June 1992, among 50 patients initially referred for heart transplantation, 46 showing myocardial viability underwent bypass grafting. Forty-five of these 46 patients were men, and the mean age was 58 +/- 12 years (range, 40 to 70 years). Congestive heart failure was present in all patients, and dyspnea was the main symptom in 80% (37/46). Patients were selected according to three criteria. (1) Myocardial viability was primarily assessed by thallium scintigraphy for up to 24 hours (28/46 patients). When results were negative, patients underwent positron emission tomography (20/46 patients). (2) Regional left ventricular function was assessed using gated blood pool single-photon emission computed tomography combined with (3) full hemodynamic evaluation. Results were as follows: end-diastolic volume, 129 +/- 35 mL/m2; ejection fraction, 0.23 +/- 0.06; cardiac index, 2.4 +/- 0.62 L.min-1.m-2; mean pulmonary artery pressure, 26 +/- 0.90 mm Hg; and mean pulmonary capillary wedge pressure, 16 +/- 1.10 mm Hg. Operative mortality was 2.17% (1/46). During follow-up (mean duration, 18 months), there were three late cardiac-related deaths (arrhythmias) and two noncardiac-related deaths. The 40 long-term survivors are in New York Heart Association class II. Angiography (15 patients) or gated blood pool single photon emission tomography (32) showed improvement in mean ejection fraction to 0.39 +/- 0.13 (range, 0.22 to 0.46).(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of the long-acting somatostatin analogue SMS 201-995 on growth rate and reduction of predicted adult height in ten tall adolescents.

Ten adolescents (four boys and six girls) aged 11.5 to 17 years, presenting with constitutionally tall stature were treated with twice daily subcutaneous injections of 250 micrograms of SMS 201-995 (Sandostatin). Results are reported after 6 and 12 months of therapy. Reduction of growth rate was obtained in 9 patients and correlated with the reduction of 24-hour growth hormone pulsatility and with the decrease of plasma Somatomedin-C values. Moreover, acceleration of bone maturation on SMS 201-995 therapy occurred in seven patients, and mean bone age increased from 13.3 years to 14.5 and 15.8 years after 6 and 12 months of SMS therapy. The mean reduction of predicted adult height was 4.9 cm at the last evaluation after 6 or 12 months of therapy. The dual effect of SMS 201-995 on growth rate and bone maturation suggests that it may be an alternative treatment to reduce adult height.

Long term effects of continuous subcutaneous infusion of the somatostatin analog octreotide in the treatment of acromegaly.

The marked pituitary tumor shrinkage achieved by continuous sc infusion (CSI) of the long-acting somatostatin analog octreotide in one acromegalic patient led us to treat 16 other acromegalic patients for up to 24 months by CSI. This therapy, given in doses ranging from 100-600 micrograms/day, resulted in normalization of the mean daily serum GH (mGH) and insulin-like growth factor I levels in 9 of the 17 patients (53%). In 7 patients, mean daily serum GH decreased but not to normal; 3 of these patients had hyperprolactinemia which was not influenced by octreotide. One patient was completely unresponsive. In contrast to the biochemical results, 80% of the patients had marked clinical improvement. Side-effects consisted of slightly impaired carbohydrate tolerance in 2 patients and cholelithiasis in 2 patients. Pituitary tumor size decreased in only 3 patients; in 1 of them visual field defects disappeared rapidly. These results suggest that octreotide treatment may prove beneficial before surgery in patients with macroadenomas, although its efficacy varies widely. Potential responsivity can usually be determined by a short course (24 h) of CSI of octreotide.

[Scintigraphic detection of pheochromocytoma metastases. Morphologic control apropos of a case]. / Détection scintigraphique des métastases de phéochromocytomes. Contrôle morphologique à propos d'un cas.

The authors report a case of malignant pheochromocytoma. They explain the difficulties of the diagnostic of malignancy which can only be confirmed by metastases. Radioisotope scanning with I131 metaiodobenzyl guanidine is the best available method to locate the primary tumor and the metastases. The results of radio isotope scanning are compared to the ultrastructural study.

[Isotope transit in reflex sympathetic algodystrophy]. / Transit isotopique au cours des algodystrophies sympathiques réflexes.

It has been shown in radioisotope scans made three hours after injection of 99mTc MDP that a significant hyperfixation in bone extremities is present in causalgias, probably due to accelerated osteogenesis. However, this gives no information concerning blood circulation inside bone. Nevertheless, the kinetic activity of tracer in areas of lesion for the initial seconds after injection depends upon the vascularity of this region. The computerized recording of isotope activity forms an early activity curb (isotope transit) which can be compared to the activity curb of the corresponding healthy articulatory region of the other limb or side. This curb breaks down into two parts: first, a rapidly ascending slope that corresponds to infiltration of the periarticular arterial network; second, a slowly ascending slope that corresponds to the tracer diffusion space in bony extremities. Among the 27 cases of causalgia in our series 19 evolved into thermalgias in less than three months. Furthermore, in 18 of these 19 cases the lesion-side activity curb was significantly different from the aspect of the healthy side's curb in that both portions showed a hyperactivity. The initial "arterial" hyperactivity slope probably corresponds to an increase in arterial blood flow (and sometimes circulatory speed) in soft tissues around joints; subsequent hyperactivity, gradually increasing, probably corresponds to an increase in the vascular bed volume and diffusion surface due to functional entry of usually silent intraosseous capillaries. Thus, the causalgia which has become thermalgic has a typical initial isotopic tracing curb: this hyperfixation explains the anatomic and pathophysiologic disorders evidenced by other procedures in this disease.

[Experimental model for hemodynamic and metabolic studies of extracorporeal circulation. Apropos of 14 cases]. / Modèle expérimental pour l'étude hémodynamique et métabolique de la circulation extra-corporelle. A propos de 14 cas.

The authors present an homogeneous and stable experimental model, the basic characteristics of which are: 14 extracorporeal bypass with: total bypass; normothermia; total haemodilution; beating heart; continuous flow in dogs anesthetised with chloralose. Three methods were employed: continuous recording of the venous lactate concentration; invasive electromagnetic measurement of the arterial blood flow; measurement of the tissular capillary blood flow with radioactive labelled microspheres. The statistic treatment of the informations gathered confirms that those experimentations took place in normothermia and constant: pH, venous and arterial pressure, cardiac pacing and arterial carotid blood flow. We noticed no modification of the body electrolytic repartition; blood gas variations do not modify haemodynamic conditions. Increase of the lactate concentration, as noticed in the literature, is in relation with a catecholamine hypersecretion and not with an anaerobic tissular function. Tissular capillary blood flow is constant if reported to cardiac index. This model will allow us to compare those results with new series where only one of the basic elements will be modified.

Is osteonecrosis of the femoral head avascular? Bone blood flow measurements after long-term treatment with corticosteroids.

Since nontraumatic osteonecrosis of the femoral head is usually considered primarily as an ischemic disease, blood flow has been studied in femoral segments in two groups of geese, one control group and the other treated with a high dose of corticosteroids for 5 months. There was no histologic evidence of osteonecrosis in femoral heads, and mean bone blood flow in any femoral segments was not reduced in the treated group. These results suggest that osteonecrosis of the femoral head is not caused primarily by ischemia, even if ischemia may play a secondary role in the evolution of the disorder.

Further studies on the relationship between platelet buoyant density and platelet age.

The relationship between platelet buoyant density and platelet age was investigated in eight human subjects submitted to an autologous chromium labeled platelet survival study. Platelets were isolated after isopycnic centrifugation using eight discontinuous isoosmotic stractan gradients (five subjects), or various continuous and linear isoosmolar gradients (three subjects). A paradoxical radioactivity enrichment of the dense platelets and a premature loss of radioactivity in the light platelets were observed. These results are explained by a shift of the radioactivity distribution curve toward higher densities during the 3-4 days after platelet injection, while the standard deviation of the distribution was conserved throughout the platelet life span. These results suggest that young platelets are heterogeneous and slightly less dense than the total platelet population.

Cerebral circulatory effects of a dopaminergic agonist (apomorphine) in the dog.

Dopaminergic influence upon cerebral circulation was studied in 12 adult mongrel dogs, local cerebral blood flow (lCBF) being measured by the microspheres method. The intravenous injection of apomorphine (0.1 mg/kg) produced heterogeneous effects on lCBF; an increase in lCBF reaching the level of statistical significance was observed in frontal and sensory motor cortices, whereas blood flow was not significantly altered in the other regions examined. When the animals are considered individually, a widespread response was generally observed. Local cerebral blood flow increased from 16% to 85% (depending on the regions examined) in 4 animals, and tended to decrease (particularly in the caudate nucleus) in the 8 others. These opposite effects cannot be related with changes in general metabolic or hemodynamic parameters (PaCO2, PaO2, pH, and arterial pressure). It is thus concluded that the effect of dopaminergic stimulation upon cerebral circulation is more complex than previously reported. These effects could only be partly mediated via vascular receptors and could be the result of modifications of the local metabolic level.

[Revascularization using the greater omentum. Results of an experimental study in dogs. Clinical perspectives (author's transl)]. / Epiploon et revascularisation. Etude expérimentale chez le chien. Perspectives cliniques.

An experimental study was conducted in dogs to study the increase an vascular supply to an ischemic zone after transplantation of the greater omentum. The study design, applied in eleven dogs, is described, and the various technical details emphasized : staged vascular ligature of one paw, preparation of the omentum, and transplantation using microsurgical procedures. The circulatory deficiency, evaluated by comparison with the healthy or similarly ligatured opposite paw, is well-compensated by the omental transplant, and a new circulation is established. This is apparent on pathological examinations and arteriography. Isotopic angiography, by means of labelled erythrocytes, supplies proof that a vascular pool is effectively derived from the transplanted organ and that it reaches the distal region of the ischemic limb. The increase in blood supply obtained suggests the possibility of new clinical indications. Apart from omentoplasty, already widely used in plastic surgery, the omentum could perhaps also be effective in certain areas of cardiovascular surgery, especially in some cases of arteritis where the distal vascular bed is greatly reduced. Further experimental studies, such as these described, are necessary before using this technique in humans.

Regional femur blood flow measurements with radiolabelled microspheres in fatty liver-induced or corticosteroid treated animals: preliminary report.

Using radio-labelled microspheres, the authors studied bone blood flows in various segments of goose femurs (femoral head, trochanter, condyles). Experiments were conducted on three groups of geese: control, fatty liver induced and corticosteroid-treated animals. The preliminary results suggest that hyperlipemia and fatty liver conditions do not seem to obviously disturb intra osseous blood circulation in fatty geese, although corticosteroids might affect bone blood flows in condyles.

[Local osseous blood flow measured with radioactive microspheres: correlations with intra-medullary pressures]. / Débits osseux locaux mesurés par microsphères radioactives: corrélations avec les pressions intra-médullaires.

The authors studied in the dog, using radioactive microspheres, the blood bone outputs of the trochanter, the femoral diaphysis and the tibial diaphysis, and measured, in a simultaneous fashion, the intra-medullar pressures in these bone regions. A same hierarchy of outputs is consistently found in all animals : the trochentarian outputs are always the highest, and next come, in decreasing order, the outputs of the femoral diaphyses and the tibias. On the other hand, the intra-medullar pressures, although differing according to the bone regions, always have rather superposable rates, so that the neighboring intra-medullar pressures always correspond to radically different outputs. It is thereby demonstrated that the intra-medullar pressures, as an isolated parameter, cannot accurately reflect the rate of bone output.

[Marrow scintigraphy in Paget's disease of bone (author's transl)]. / La scintigraphie médullaire dans la maladie osseuse de Paget.

Marrow scintigraphy using 99mTc colloids was performed in 20 patients with Paget's disease of bone and compared with skeletal scanning in each of them. As long as the regions explored were haematopoietically active, despite the advanced age of the patients, there was decreased marrow uptake in regions of increased uptake on the skeletal scan. Whilst increased uptake of pyrophosphate reflects bone hyperosteogenesis, decreased uptake of colloids reflects marrow fibrosis, and early histological sign of the disease. This scanning technique could be a new criterion in the surveillance of the therapeutic effectiveness of calcitonins or of diphosphonates.

[Thyroid carcinomas. Critical study about 138 observations. Therapeutic deductions (author's transl)]. / Cancers thyroïdiens. Etude critique de 138 observations. Déductions thérapeutiques.

Between 1952 and 1973, 138 patients with thyroïd carcinoma have been recorded. From the critical study of these cases, the pathological, etiological and clinical features have been studied. Different therapeutic modalities are evaluated from these cases. Surgery was always used when possible. A hemithyroïdectomy was realised most often. We stress that sterilisation was obtained by 131I treatment in plurifocal metastasis, particularly in pulmonary metastasis, only when the iodine uptake was sufficient. Survival has been evaluated according to the pathology: papillary and vesicular carcinomas have a good prognosis (the papillary and vesicular survival rate at 10 years reaches respectively: 65% and 64%). Anaplastic carcinomas have a bad prognosis (the survival rate at 5 years is 18%, at 10 years, 0%. These results are similar to those published by differents authors. At the opposite, trabecular carcinomas have a very short survival (8% at 5 years, 7% at 10 years) which is very unusual in well differentiated thyroïd carcinomas. It has to be isolated from the others.